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Why are my father's abilities improving and then regressing since his stroke?

6 answers
| Last updated: Dec 07, 2016

A fellow caregiver asked...

Since my dad's stroke, his progress has seemed to bounce back and forth. For a while, he couldn't talk at all but could follow some instructions. Now he can vocalize some words but isn't following instructions at all. What could be going on?

Expert Answers

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

In general, patients should slowly improve after a stroke. After about two years, this improvement tends to slow down substantially. However, any reappearance or worsening of symptoms should prompt a medical evaluation.

When a patient's rehabilitation moves in the wrong direction, it may be that he has another undiagnosed illness that's delaying his recovery. Several conditions -- including pneumonia, urinary tract infections, and another stroke -- are common after a stroke, and most can worsen stroke symptoms. Depression and certain changes in medication can also cause such setbacks.

Talk to your father's doctor about what you're seeing. She should be able to determine what's going on.

Community Answers

W4l answered...

Stroke Recovery
Stroke recovery requires a tremendous amount of focus on a daily basis. I have been involved with professional fitness and conditioning training for 40years "“ and personally suffered a serious stroke 11years ago.
From my personal experience with rebuilding my own life and working with others to rebuild theirs, I am 100% convinced that you can recover a truly significant amount of your life [if not all] with the right daily disciplines and focused efforts. For many, that will require the daily assistance from others who are trained to provide the activities, etc.
This is not an experience that you simply rehab and then, go on with your life. This will require a discipline of focused activities for the rest of your life "“ or, you will lose much of what you have recovered.

A fellow caregiver answered...

W4L,

I would like to know more about your stroke regime.

My husband had a stroke amost two years ago, has had physical therapy through Jan 2010.
He is now in a clinical trial, using intense sessions of physical therapy, three hours a day.

This program will last 10 days and then he is "on his own".

He walks wilth a guad cane, has no use of his left arm/hand.
Would like to know what else we can do.
Thanks

Bron too answered...

My husband had a stroke in Nov 2007. His stroke was frontal lobe, right side so his left body was affected.

He had about 6 months of traditional rehab which was 1 month in patient and then the rest out patient for 3 hours, 4 days week (combination of physio, OT, speech therapy, exercise physiology). At the end of this time he could walk reasonably well and had minimal movement in his left arm/hand. He was out of a sling and had some major limb movement, but not a lot of fine control.

We were then "on our own". Within 3 months, his capabilities had degraded. We bought a biomove to help with fine movement of his hand. He has resisted the sort of intense effort that constraint based therapy (google it) involves. But we now have a physio or OT come to our home for an hour a week. He does some other work in our local gym (a program devised by the physio).

Our experience is that if you don't maintain the activity, you lose capability. His walking is worse than it was. However, his arm has greater movement than it did have, but it is very much up and down. He is currently using splints to protect against the "clawing" in his hand.

He has had several seizures - they didn't tell us to be alert for these! The worst resulted in 5 compression fractures of his spine. This also put his progress back enormously and the new medication to prevent the seizures has made him very tired and as a result he does less exercise.

It's a pretty tough journey. I think that the CBT and Modified CBT offer enormous potential, but it's very hard to get his engagement on this. If you haven't done so, I suggest that you read up on brain plasticity - particularly Doige's book, The Brain that Changes Itself. I think that the regime you describe may be CBT ... however my major criticism of the heatlh industry is that you are always left on your own! It's an ongoing thing.

A fellow caregiver answered...

W4L
Love your answer--- goes along with all I have read. finding a fitness trainer for my father vs a "cognitive rehab" phys therapy program is difficult in this area.
what are you doing? any program or researcher you are following?

W4l answered...

Stroke recovery requires a tremendous amount of focus and commitment on a daily basis – on the part of the patient and normally, (unless you have the resources to find and hire an exceptional and unusually knowledgeable individual to assist you) this would definitely include at least one family member/caregiver. Whoever this is has to know or learn the basics on how to proceed – and develop a clearly delineated plan – with flexibility and tender love and care – but, at the same time with total focus and determination.
Obviously, depending on the type and severity of the stroke, and the individual’s other health related issues, you have to develop a carefully, completely detailed assessment of each component of what “recovery” means for this individual. You/someone has to address every facet individually and collectively – and the treatment protocol has to address these issues individually and collectively.
A major challenge for almost every stroke survivor – is to stay motivated, focused and determined – and not to become overwhelmingly depressed. Again, depending on the seriousness of the stroke, this burden may fall completely on the family/caregivers to provide the continuous inspiration and motivation.
If the patient themselves is incapable, someone has to “completely quarterback” the treatment program. This includes everything from to the obvious benefits of the ongoing physical / exercise therapy, to nutritional considerations and therapy (diet is important), to possible music therapy and massage therapy.
If the exercise and diet considerations are not addressed immediately, it is my feeling that the individual is at serious risk of falling victim to other possible serious health related issues.
As I mentioned previously, I have been involved with professional fitness and conditioning training for 40years – and personally suffered a serious stroke 11years ago. From my personal experience with rebuilding my own life and subsequently, working with others to rebuild theirs, I am 100% convinced that you can recover a truly significant amount of your life [if not all] with the right daily disciplines and focused efforts. For many, that will require the daily assistance from others who are trained to provide the activities, etc. This is not an experience that you simply rehab and then, go on with your life. This will require a discipline of focused activities for the rest of your life – or, you will lose much of what you have recovered.

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